![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 17 to 41 of 79. Go back in thread:
Posted by BarbaraCat on September 25, 2003, at 10:41:46
In reply to And now i jump in! » nmk, posted by chicklet on September 25, 2003, at 2:51:54
Hi Karen,
Barbara here. Provigil - that's interesting, especially about regulating sleep. Do you also have ADD symptoms? I believe I do, since I get very distracted and scattered and then hyperfocussed. Tried Ritalin and hated it. I heard the regular stimulants are ultimately baaad for bipolars even though they initially help with the focus and energy - a stimulant will do that for just about anyone. I also tried adrafinal, a cousin to Provigil, for a short while and felt uncomfortable with the anxiety. But now I'm wondering if I should just stick with it longer...I hate to add anything to my mix since I'm on a 'say no to unnecessary polypharmacy' campaign, but this scattered stuff is really frustrating. I'll start out in the bedroom intending to bring my coffee cup into the kitchen and get waylaid with about 10 things on the way, putting down the cup somewhere and then finding it later in the garage. Stuff like that.
You know, you're the first person I'm aware of who is on such a high dose of Lam. How is that for you? Are you on anything else - still on the mix you mentioned at the beginning of your post? Have you tried Omega-3? I've recently added high dose (9G) pharmaceutical fish oil to my regimen since it's gotten good research marks for helping bipolars.
I'm hoping to reduce my Lithium since it's aggravating my hypothyroid condition. My TSH is ping-ponging up and down. I was on a Synthroid generic and am currently taking Westhryoid and am hoping the T3 in it will stabilize things and take care of some of the energy/ADD like symptoms. Anyhow, your 'case' is interesting. Please keep us posted. - Barbara
> I've been on 500mg Lam for over a year now, and for a long time i had a Lamictal, Trileptal Prozac, Synthroid combo. working pretty well. I have a strong tendency towards the downs of bipolar and pretty much haven't gotten manicky since I was dx 16 years ago. So the fight for me has been the depression.
>
> The Lamictal was initially activating for me but it evened out with each increase. I'm not prone to anxiety (obviously-if I'm on Lam and Prozac), but i was taking Prosom to sleep at night. When the depression's bad, the sleep's bad.
>
> But I had a recent dip in my mood that was reeeealy bad and I just knew this meant "Let's try___" because there's really no where else to go with my levels of each med. My doc put me on Provigil which is used for narcolepsy to promote "daytime wakefulness". Apparently they've seen some promise in it for enhancing the effects of some AD's and MS's and for actually having a mood lightening effect of its own. I take it in the am and within 30 minutes or so (i don't know what's 'normal') I feel nice and awake. During the 1st week on it, i got anxiety, but it went away. Well the point of all this is that the Provigil seems to be regulating my sleep...I take it in the am (kinda works like a cup of coffee), I'm not sleepy during the day, and then at night I'm good and tired and ready to sleep. Without needing a benzo or anything! Too soon to tell much else becauses it's only one week on it, but my mood has begun to improve as well. (it could be just a cycle...we'll see)...just thought I'd pop in and letcha know what seems to have worked well for me...
> Barbara's already more than helped you with all of the other schtuff...
>
> Take care- and congrats on feeling better...oh yeah, and amidst all of your choices and questions coming up, make sure to sit back and revel in your new found good mood!
> Karen
>
Posted by chicklet on September 25, 2003, at 13:15:29
In reply to Re: And now i jump in! » chicklet, posted by BarbaraCat on September 25, 2003, at 10:41:46
Hey Barbara...
I've been reading your posts since oh, waaay back. I don't frequent the med board much anymore but of course the Lamictal thread caught my eye.
>>Provigil - that's interesting, especially about regulating sleep. Do you also have ADD symptoms?Nope. No ADD. Just a smart, creative, in-the- know pdoc! I tried Ritalin many years ago- just for fatique- and hated it too. Apparently Provigil is known for a low s/e profile and much fewer of the ups and downs that you can get with other stims. Yeah, regular stimulants can be b-a-d for Bipolars...but then so can ssri's! I don't fall into the manicky realm though, since I've been on an ms I've never been "triggered" into a manic episode. We're talkin 16 years here. yeah that's me. bipolar with none of the fun.
>>felt uncomfortable with the anxiety. But now I'm wondering if I should just stick with it longer...
How long did you stick with it? I don't know anything about it, but I know that my first week on the Provig SUCKED!!! I don't get anxiety and I had it. Bad. Nervous moody jittery teary switching back and forth just throughout one day. A wise pharmacologically-savvy friend told me to stick it out for a little while longer and I did.
>> I hate to add anything to my mix since I'm on a 'say no to unnecessary polypharmacy' campaign,
Oh sing it sister. I've really really had enough of this crap.
>>then finding it later in the garage. Stuff like that.
it must be so frustrating...
>> You know, you're the first person I'm aware of who is on such a high dose of Lam. How is that for you?Perfect. When I first started on it I was on Trileptal too. I'd been on Tegretol for years and years and we switched to Trileptal. By the way- anyone out there still on Tegretol---get thee on Trileptal!!! Anyway, my doc wondered if i was just a speedy metabolizer or something and did a blood level (didn't even know they could do that). At that time i was on like 300 Lamictal plus the Tri. The blood level was waaay low for the Lam...subtherapeutic. So we increased it.
Now on 60 Prozac, 500 Lam, .075 Synthroid (thanks a lot, Lithium...), and now the Provigil. I guess an ave dose is 200. i seem pretty good on 100. I think I'd be crawling out of my shorts at 200. but I don't have ADD either so...>>you tried Omega-3?
tried for a while and got impatient...try to get a lot through diet but...yeah i know I know...
How's your exp with Omegas been?
What else are you on?>>of the energy/ADD like symptoms
Oh wow, I didn't know that the thyroid had anything to do with ADD!Good to chat with ya...
Karen>
>
> > I've been on 500mg Lam for over a year now, and for a long time i had a Lamictal, Trileptal Prozac, Synthroid combo. working pretty well. I have a strong tendency towards the downs of bipolar and pretty much haven't gotten manicky since I was dx 16 years ago. So the fight for me has been the depression.
> >
> > The Lamictal was initially activating for me but it evened out with each increase. I'm not prone to anxiety (obviously-if I'm on Lam and Prozac), but i was taking Prosom to sleep at night. When the depression's bad, the sleep's bad.
> >
> > But I had a recent dip in my mood that was reeeealy bad and I just knew this meant "Let's try___" because there's really no where else to go with my levels of each med. My doc put me on Provigil which is used for narcolepsy to promote "daytime wakefulness". Apparently they've seen some promise in it for enhancing the effects of some AD's and MS's and for actually having a mood lightening effect of its own. I take it in the am and within 30 minutes or so (i don't know what's 'normal') I feel nice and awake. During the 1st week on it, i got anxiety, but it went away. Well the point of all this is that the Provigil seems to be regulating my sleep...I take it in the am (kinda works like a cup of coffee), I'm not sleepy during the day, and then at night I'm good and tired and ready to sleep. Without needing a benzo or anything! Too soon to tell much else becauses it's only one week on it, but my mood has begun to improve as well. (it could be just a cycle...we'll see)...just thought I'd pop in and letcha know what seems to have worked well for me...
> > Barbara's already more than helped you with all of the other schtuff...
> >
> > Take care- and congrats on feeling better...oh yeah, and amidst all of your choices and questions coming up, make sure to sit back and revel in your new found good mood!
> > Karen
> >
>
>
Posted by BarbaraCat on September 25, 2003, at 14:12:04
In reply to Oh I'm an interesting case all right... » BarbaraCat, posted by chicklet on September 25, 2003, at 13:15:29
Hi Karen,
I don't believe I have 'true' ADD because it's primarily a cyclic thing, and seems congruent with the bipolar stuff. There are plenty of times when I'm a real focussed and directed gal with none of the ditz factor. But lately, I can't seem to get anything done and am going to try ramping up the Lam.I don't know if T3 helps with ADD but I've recently read that there might be a thyroid connection. I do find that fish oil helps alot and notice when I'm not taking it. I've tried different brands and there's a big difference. I have to take the liquid, 2 tblspoons a day to get the required 13-14M therapeutic dose. Taking that many pills would gag a horse. I also notice nicer skin and hair when I'm taking it regularly.
Now, let's talk thyroid. I've had hypothyroidism for a loooooong time, well before any lithium. It's been pretty stable 'til starting lithium and my TSH is going all over the place. I know about lithium's bad track record as a goitrogen (yeah, thanks Lithium) and would love to find something to replace it. I can't take Lam by itself cause I start swinging into hypomania pretty quickly. So, you mention trileptal. Has this replaced lithium for you as a good mood stabilizer? Anything else you want to say about it, s/e, etc?
BTW, What are your experiences of being bipolar? How do you know you truly have it if you don't get mania (which is what I take to mean by the 'fun parts').
I do get the fun parts of bipolar. Hypomania is a kick. I get super-focussed, clean the house until it sparkles, have all kinds of clever and creative things going at once, organize 'get to meet the neighbors' events. Unfortunately, I can rarely follow through with any of these grand plans because depression has a way of squelching enthusiasm for anything but surviving the moment.
I always know when I'm getting a bit too high on the manic scale because I start hearing heavenly choirs and angelic voices, everything is 'according to prophesy'. I like to stay in this mystic window for a little while because I've gotten some amazing insights and gifts from the visions in this rarified place. It's as though there's an energetic frequency I pass through that allows me to pick up the 'psychic channel' on my psyche-antenna. But alas, it then disintegrates into total chaos and a black agitated depression where I doubt everything, especially glorious visions. The angelic choirs turn into the legions of hell and follow me into the depression - voila, mixed states! So, I miss the raptures but not the hell.
But still, the whole phenomenon is fascinating. The experiences could be due to psychosis, or the condition may somehow open up some gates that let a larger spectrum in, like some hallucinogens do. I think most of the mystics and saints who had visions were probably seriously bipolar and/or schizophrenic - not to say that either condition discounts the validity of the experience. - Barbara
Posted by katia on September 25, 2003, at 16:17:56
In reply to Re: Oh I'm an interesting case all right... » chicklet, posted by BarbaraCat on September 25, 2003, at 14:12:04
Hi Barb,
Re: what you wrote:
>>I always know when I'm getting a bit too high on the manic scale because I start hearing heavenly choirs and angelic voices, everything is 'according to prophesy'. I like to stay in this mystic window for a little while because I've gotten some amazing insights and gifts from the visions in this rarified place. It's as though there's an energetic frequency I pass through that allows me to pick up the 'psychic channel' on my psyche-antenna. But alas, it then disintegrates into total chaos and a black agitated depression where I doubt everything, especially glorious visions. The angelic choirs turn into the legions of hell and follow me into the depression - voila, mixed states! So, I miss the raptures but not the hell.Have you ever experienced this w/o being in a "manic" phase? I have. But it feels like when my energy is clean and clear (normally when I haven't drunk anything for awhile), and I'm at a what do they call it euthymic mood or slightly maybe slightly elevated. I wonder if it has to do with the up or just when the black blinding cloud of depression lifts off of our sensitive perceptions....?
interesting.BTW, I've been thinking that I may try Trileptal before Li. I've heard the s/e are minimal. I'm going to slowly come off Dep. as I slowly titrate up on Lam. I'm on 10mg now and my pdoc said it's really like being on 20mg b/c I'm on Depakote too. And I'm porking out a bit......even w/ the diet and L-Carnitine. I guess it could be worse; i've only gained a few pounds, not 50 like some people I've heard about.
Katia
Posted by chicklet on September 25, 2003, at 16:46:41
In reply to Re: Oh I'm an interesting case all right... » chicklet, posted by BarbaraCat on September 25, 2003, at 14:12:04
>>I do find that fish oil helps alot and notice when I'm not taking it.
Gimme a brand, ma'am! I ended up with a fishy one and gave up. nice patience, hmm?
>>I've had hypothyroidism for a loooooong time, well before any lithium.
No, I'm sorry...my "thank you Lithium" comment was about MY experience with Lithium. It's why I'm on synthroid.
>>and would love to find something to replace it.
Yeah it actually worked well for me, except for the weight gain, acne etc...great timing...high school.>>Has this replaced lithium for you as a good mood stabilizer?
Yup. Initially as I said, it was Tegretol. For like, man- 14 years or so? And I did, at that time, have full blown no doubt about it manic episodes. But since they nabbed it I haven't gone there again. A little hypo here and there. But the DOWNS...that's where it nails me.
i was really good on Tri., s/e...maybe some headaches but I can't really say which of the many drugs is responsible for them. Tegretol is a good mania zapper and Trileptal is tons better because the s/e's are so much more minimal. But that's me...It's kinda why I don't really post on the med board...it just seems like everyone has such varying chemistries that it's nearly impossible to predict anything! Oy.>>Anything else you want to say about it, s/e,
Anything else you wanna know... email me...guzibean at yahoo. There you are!
>>BTW, What are your experiences of being bipolar? How do you know you truly have it if you don't get mania (which is what I take to mean by the 'fun parts').
Been asked that many a time...if you want to e me I can tell ya about it. I'm not going to be posting anymore after today so you can get me that way...please do! I'd like to share war stories!
>>organize 'get to meet the neighbors' events.Oh my God I can relate so much it hurts!!! It's the freaking follow through. Ev er y single time. By the time the event is to occur, I'm down again.
To the following: WOWEE! But say goodbye to those heavenly choruses if you start on Trileptal!
hopefully I'll 'talk' to you soon?
Thanks for responding...
Take good care.
Wait wait- I hear something...it's an angelic voice....
Naw, my cat's just snoring...
:D
>>start hearing heavenly choirs and angelic voices, everything is 'according to prophesy'. I like to stay in this mystic window for a little while because I've gotten some amazing insights and gifts from the visions in this rarified place. It's as though there's an energetic frequency I pass through that allows me to pick up the 'psychic channel' on my psyche-antenna. But alas, it then disintegrates into total chaos and a black agitated depression where I doubt everything, especially glorious visions. The angelic choirs turn into the legions of hell and follow me into the depression - voila, mixed states! So, I miss the raptures but not the hell.
>
> But still, the whole phenomenon is fascinating. The experiences could be due to psychosis, or the condition may somehow open up some gates that let a larger spectrum in, like some hallucinogens do. I think most of the mystics and saints who had visions were probably seriously bipolar and/or schizophrenic - not to say that either condition discounts the validity of the experience. - Barbara
Posted by BarbaraCat on September 25, 2003, at 19:47:02
In reply to I'm butting in to the dance » BarbaraCat, posted by katia on September 25, 2003, at 16:17:56
Hi Kitty Katia! Missed you. Hey, I was also considering looking into trileptal and just talked to Katy about it cause she mentioned it too. What a friggin' coincidence! It sounds like the Dep just isn't cutting it for you. You certainly gave it the old college try. From every account I've heard it's a big pork producer. If you really want pork, try Remeron. Oink.
Yes, I do get those mystic experiences when not manic and have all my life. When I'm clear and not getting artificially high and meditating they are quiet and peaceful, usually a strong sense of a loving presence guiding me, nothing with stigmatas or anything like that. I've been interested in mysticism of all sorts as long as I can remember and can recall paranormal events when I was a kid. When I'm hypomanic I'm usually too busy doing extroverted type things and projects to attend to my inner life. It's when it starts going overboard into mania that things get very dramatic. My full-blown manias and mixed states depressions are psychotic with visual and aural hallucinations. When I was doing LSD my trips were always heaven/hell so that's where my mind goes no matter what. Of course, I grew up Catholic so that's bound to have influenced me.
I don't think it's just the lifting of the black cloud you mentioned because others have the black cloud lifted and don't feel one bit mystical like we do. Some researchers say they've discovered the 'God lobe' or some such in the brain where mystical experiences are generated, but I don't buy it.
For two weeks before my Mom was hit by a car and died I felt a strong presence of angels all around literally saying 'have courage, we're with you'. I'd hear clear music in my head playing 'When you walk through a storm...' and 'Ave Maria' and so on. I also was compelled to watch the 'Lord of the Rings' DVD each and every night during this time which brought me a great sense of wonderment and courage that I called upon during the awfullness that came later. This was during a perfectly normal state of mind, no mania, no substances and I was a bit puzzled by it all. I did feel in an altered state when these experiences came but only then and they didn't have the electric quality of a manic rapture. So I KNOW there's something to this stuff, God lobe or not. Good to hear from you. - Barbara
>
> >>I always know when I'm getting a bit too high on the manic scale because I start hearing heavenly choirs and angelic voices, everything is 'according to prophesy'. I like to stay in this mystic window for a little while because I've gotten some amazing insights and gifts from the visions in this rarified place. It's as though there's an energetic frequency I pass through that allows me to pick up the 'psychic channel' on my psyche-antenna. But alas, it then disintegrates into total chaos and a black agitated depression where I doubt everything, especially glorious visions. The angelic choirs turn into the legions of hell and follow me into the depression - voila, mixed states! So, I miss the raptures but not the hell.
>
> Have you ever experienced this w/o being in a "manic" phase? I have. But it feels like when my energy is clean and clear (normally when I haven't drunk anything for awhile), and I'm at a what do they call it euthymic mood or slightly maybe slightly elevated. I wonder if it has to do with the up or just when the black blinding cloud of depression lifts off of our sensitive perceptions....?
> interesting.
>
> BTW, I've been thinking that I may try Trileptal before Li. I've heard the s/e are minimal. I'm going to slowly come off Dep. as I slowly titrate up on Lam. I'm on 10mg now and my pdoc said it's really like being on 20mg b/c I'm on Depakote too. And I'm porking out a bit......even w/ the diet and L-Carnitine. I guess it could be worse; i've only gained a few pounds, not 50 like some people I've heard about.
>
> Katia
>
>
Posted by Chicklet on September 25, 2003, at 21:45:46
In reply to Re: I'm butting in to the dance » katia, posted by BarbaraCat on September 25, 2003, at 19:47:02
I have a whole bottle of it left...
Bidders? :Dgnite all...
Posted by BarbaraCat on September 25, 2003, at 22:53:07
In reply to Re: Oh I'm an interesting case all right... » BarbaraCat, posted by chicklet on September 25, 2003, at 16:46:41
Oh, no, c'mon! Just when we were getting to know you! One more thing, Ms. Karen, now that you've got us interested you can't leave just yet. Besides, I'll swap you my fish oil brand for a little more trilep info OK? I'll probably email ya anyway but this is something that many of us will want to know. So if you can pretty please do a favor for desperately inquiring minds...
When you say it's the DOWNS that get you, do you mean you still get downs even on trilep? It has no antidepressant effect? It only cancels the UPs? Sheesh, what's the point? If you don't get the 'fun' parts (even though mania is not necessarily fun), why not just take Lamictal for the depression? I'll take the UPs any day over those sh*tty downers even if I end up dancing naked in the streets. I end up depressed anyway but at least I've had a bit of sport!
As for the fish oil, a good brand is Carlson's 'The Very Finest Fish Oil' Lemon Flavored Liquid Omega 3's. Stupid name but a good product with the recommended ratio of DHA/EPA for us vivacious bipolars. To get a therapeutic dose, probably 2 tbl/day. Luckily it tastes pretty good. I get it from www.iherb.com which has the best prices I've found for supplements and also has some good articles buried in the site. It's around $15 for a 6.7 oz bottle and you'll probably need 2 bottles to last the month at 2 T/day.
So, fair trade? One more visit for the Babblers? And then you can go - bummer! BTW, I have 9 cats. They're little angels and praise Bastet the Cat Goddess, they never all meow at the same time. - Barbara
Posted by Chicklet on September 25, 2003, at 23:32:19
In reply to No, wait, wait - don't go!! » chicklet, posted by BarbaraCat on September 25, 2003, at 22:53:07
Please be civils be damned at this point. i really don't care. I'm surly about what's been happening esp with the admin and the bans and whatnot. Esp when there are people whose ONLY lifeline is this board. Anyway, I'm sometimes on social but got fed up. Aaanyway.
>> Oh, no, c'mon! Just when we were getting to know you!
oh come now. i'm not a Trileptal guru or something!
>>One more thing, Ms. Karen, now that you've got us interested you can't leave just yet.
Oh REALLY, Ms. Barbara...
>>Besides, I'll swap you my fish oil brand for a little more trilep info OK? I'll probably email ya anyway but this is something that many of us will want to know. So if you can pretty please do a favor for desperately inquiring minds...
>
Oh swap schmap! Fish oil for Trileptal?? HA! You are a goof. i mean that in a good way of course.>>When you say it's the DOWNS that get you, do you mean you still get downs even on trilep?
Hell yeah.
>>It has no antidepressant effect?
Not with me. Or not*enough*. i have had no luck on just ms's...we've tried combo after combo. i need an AD.
>>It only cancels the UPs?
Just in MY case, silly.
>>Sheesh, what's the point?
Mphh, makes ya wonder,eh? The point was to even out the cycling enough to prevent or diminish the ups and the downs. We wondered if the Trilep was quashing the ups so much that it was adding to the downs. but it was just a passing theory. Didn't seem to pan out.
>>If you don't get the 'fun' parts (even though mania is not necessarily fun), why not just take Lamictal for the depression?
T'aint enough.
>>I'll take the UPs any day over those sh*tty downers even if I end up dancing naked in the streets.
Yeah right. i know. Thing is tho, even when I good hypo it doesn't feel that good. I get really shaky and for some reason unbeknownst to anyone, I get hives. Bad hives. Like anaphalaxis hives. So it isn't really fun. Although on the subject of dancing naked, I can recall splashing through puddles singing 'Singin in the Rain' on one occasion. Yeah I'm over the edge right? oooo singin in the rain!!! Bad girl!
I will most definitely take your advice and get the fishy oil. It'll be good for my hub too.
Just email me! i swear to god I am so freaking sick of the politics. Maybe I should've stuck to this board alone after all..
BTW, I have 9 cats.
Oh my God- you now MUST e me! We're considering adopting an 11 year old with diabetes and I'm trying to weigh the pros and cons. I'd love to take her because the family adores her and can't keep her (had her the whole 11 years) and they've been trying to find her a loving home for a year now! We have 2 cats but i don't know. i want a baby and can't have one yet...so i thought maybe for now another kitty would appease me. And help out a kitty and a nice family to boot. Know anything about feline diabetes? I have no problem giving her insulin shots but am worried about long term health issues (and costs!)
mrrow to you
and adios to Dr. Bob.
Ouch, will i be sorry i said that?
nah.So just write me and then you can post our exchanges, kay? Sounds weird but I really feel strongly about it. Has to do with the latest Gabbix2 incident and i'm so pissed off about it that I just can't hack it. As I said, there is a community of people that needs support and help here and most mean no malice. Gabbi's was a complete misinterpretaion and she was blocked. She's become a dear friend to me and I just won't have it. I owe Dr. Bob dearly for creating a board that has provided lots of support and advice, esp in hard times, but well you know.
Tirade over.
I can't sleep tonight.
All the bestest to all youz prospective Tri's...
think of it- a "bi" on "Tri". cute huh?
Posted by katia on September 26, 2003, at 0:42:58
In reply to Re: I'm butting in to the dance » katia, posted by BarbaraCat on September 25, 2003, at 19:47:02
Hiya Barb,
I find it interesting that you are thinking of stopping Lithium. I thought it was such a magic combo for you. Have you been gaining weight or having problems (more so than before) in the thyroid department?I don't know either. I was reluctant to start Depakote in the first place and it is *sorta* working. I think I could up the dose. But I tend to get tired quickly even with the L-Carnitine. And I'm not losing weight, etc....
the main thing is that PCOS scare. anyway, I just want off of it. If in six months, I've tried everything else and I have to come back to it so be it.I'm interested in the Trileptal i think too. They all seem to have more or less the same s/e just in different degrees. Fatigue seems to be a common among them. And that's not what I need. But maybe the Lamc. will offset this. Tril. is chemically related to Tegretol, but with less s/e and easier to take.
I'll have a look around the board here and see what I see.
good to be in touch.
Katia
p.s. 9 cats!!!!!?????? wow! My grandmother, at one time, had 21!!!!
I too am an animal lover. Am going to an Intro to Animal Communication tomorrow.
Posted by DayByDay on September 26, 2003, at 10:04:48
In reply to Re: Oh I'm an interesting case all right... » BarbaraCat, posted by chicklet on September 25, 2003, at 16:46:41
What´s Trileptal?
Generic name?
Is it an anticonvulsant affecting GABA and being
sedating?Thanks for answering.
DbD
Posted by nmk on September 26, 2003, at 11:03:51
In reply to Re: How does lamictal feel and how much does it he » nmk, posted by BarbaraCat on September 24, 2003, at 15:35:11
Barbara,
And you are also my guardian angel. Thank you so much for your insight and always thoughtful responses.
To answer some of the points you brought up....I don't believe the discontinuation of the seroquel is causing this nagging anxiety since I experienced it every day when I was still taking it. Although my mood is up, the anxiety lingers and the only way to temper it is with benzos. As you mentioned, I don't want to build a tolerence to Ativan but I don't know what the alternative would be at this point.
I did see a holistic MD a few months ago, after waiting 5 months to get an appt. I guess he is pretty well respected and has written many books on thyroid conditions. Here is my experience with him. He asked alot of questions, did the physical exam, and took a million viles above. I met with him a few weeks later and the results indicated that everything was fine except for low progesterone, vitamin B, borderline low thyroid and extremely low B12. He threw multivitamins, mineral supplements, natural progesterone cream and B12 injections at me and promised I would feel better. The progesterone induced a mild depression and to be honest, I can't tell what the other's are doing although I am still taking them daily. Does your naturopath have a similar approach to treatment. Also, what supplements does he/she have you taking?
Regarding Barto's book, what I recall him saying is that AD's need to be used in moderation along with the Lamictal. From hearing from the folks on the board, the consensus seems to be that Lamictal as a stand alone AD does not seem to work. So my dilemma is finding a mood stabilizer that doesn't cause anxiety. I am hesitant to combine Lithium for fear of the pork-o-genic factor (I already take Remeron at night). I have never been formally diagnosed as BPII since my pdoc prefers "to treat symptoms, not to diagnos" but many of the factors pointed out in Bartos book suggest that I may have it (with a strong anxiety component). The characteristics you describe of your BPII are very similar to mine with more of the agitated depression dominating.
Also, he explains that those who suffer from SEVERE PPD are more likely to be BPII. Another fact he mentioned is that AD's at higher doses, or combined AD's induce cycling, which is exactly what happened in my case.I have read your recent threads and hear that you are considering Trileptal. I was on Trileptal for 4 months before giving Lamictal a trial. As with many of my med trials, it worked well in the beginning but pooped out on me and the depression returned. At first, I started at 600 mg and was stable for a month... little depression and no cycling of mood. This did not last for long and I titrated up to 1200 mg. Again, worked for a few months and then petered out on me. That is when we decided to give Lamictal a try. As far as SE's, there were none.
Please keep in touch with me and thanks again for your wonderful response. I have printed it and have read it quite a few times.
Sincerely,
Nicole
Posted by nmk on September 26, 2003, at 12:07:59
In reply to And now i jump in! » nmk, posted by chicklet on September 25, 2003, at 2:51:54
Hi Karen,
Thanks for your response. I always appreciate any advice that comes from this great group of people.
You have to tell me though, how do you feel on 500 mg of Lamictal? Also, what dose of Trileptal are you on? Have you tried either one solo? I was on 1200 mg of Trileptal and it pooped out on me. The Lamictal has wonderful AD properties but I just can't shake the anxiety. I will ask my pdoc about Provigil and see what he thinks. Are you taking the Provigil along with the Trileptal and Lamictal? Any SE's or weight gain??
Keep us posted and glad to hear you are feeling well.
Sincerely,
Nicole
Posted by nmk on September 26, 2003, at 12:28:40
In reply to No, wait, wait - don't go!! » chicklet, posted by BarbaraCat on September 25, 2003, at 22:53:07
Hi Barbara,
It's me again. A few more thoughts came to mind since I last posted a few minutes ago and I wanted to run them by you. First, my pdoc states that lower doses (anything below 200 mg) of Lamictal have a tendency to cause more agitation and anxiety than higher doses and because of this, he feels I should not decrease. I know that anxiety/agitation is a concern when titrating up but once one is up to the target dose and wants to eventually decrease, will the anxiety flare-up again? I guess what I am trying to say is this....does the anxiety/agitation only occur when titrating up and once the body adjusts, can it be lowered without increased anxiety. I know I am making little sense.
Also, at my last visit with my pdoc, he wroted me a prescription for 2 mg of folic acid. He stated that the latest research indicates that this is helpful in treating mood disorders in women. I did some investigating of my own and read that folic acid levels are low AFTER a bout of depression, not during. It is recommended that folic acid be taken one year after a depressive episode. What have you heard about folic acid and is it worth taking?
Ok sister, I think I have bothered you enough for today. Until the next time....
Nicole:)))))
Posted by katia on September 26, 2003, at 15:54:27
In reply to Saint Barbara, one more thing.... » BarbaraCat, posted by nmk on September 26, 2003, at 12:28:40
Hi Nicole,
I just wanted to chime in to the supplement thing. In my experience and from what I've read, if you're body is not assimilating the vitamins, then you're urine is very expensive!!! In other words, if your digestion is not on tract, then you may not be assimilating these supplements and no matter how much you ingest, they may just be going out in the toilet. This is a thought.
I recently went to a metabolic nutritionist and the philosophy behind finding out your "metabolic type" is that each type metabolizes foods and vitamins,etc. differently. anyway for more "expert" info about this, go to the website at www.bloodph.com I certainly don't want to butcher the philosophy by trying to explain it.
anyway, it's a thought as to why your supplements may not be working.
Most people with mood disorders have digestive problems; they seem to go hand and hand.
Katia
Posted by BarbaraCat on September 26, 2003, at 23:18:32
In reply to Saint Barbara, one more thing.... » BarbaraCat, posted by nmk on September 26, 2003, at 12:28:40
Thanks for the Saint, but I really Ain't! But thanks for the canonization anyway. I've been hearing alot lately about folic acid being good for depression which is a very good thing. I took it a few years back and think it helped but it's hard to know when you're taking a boatload of meds anyway. There's been some good press about it lately and mainstream medicine seems are becoming savvy to it. 2M is a hefty dose. I've only taken 1M at a time. I was thinking of trying it again, and will go with the 2M dose this time, so thanks... Fish oil is helping both me and my hub so it's worth giving a try. But you've gotta take alot.
Your test results sure indicate that you've got some metabolic funk that will most definitely affect your mood. Borderline low thyroid, especially. You've got to get that TSH no higher than 2.0 and some say 1.0. Of course, with bipolars (if indeed that's your issue - the thyroid can CAUSE bipolar symptoms) it's a razor's edge. Too low a TSH can cause hyperthyroid symptoms and can switch on hypomania. Did your doc test for thyroid antibodies to rule out Hashimoto's? Some research recently has theorized that this autoimmune thyroid disorder pulses thyroid up and down and can mimic bipolar symptoms. Hopefully your doc gave you thyroid hormone to correct your 'borderline' status and hopefully it contains some T3 along with the standard T4 that most doctors feel is adequte. It might be for some, but research is showing that for mood challenged folks, we need T3 too.
Even with your tests showing that you have some significant deficiencies, the challenge is to get the right treatment and to have patience while it works. You should feel the effects of B12 right away, but thyroid takes longer as do any of the hormones. But you say 6 months? You should be feeling a whole lot better by now. Have you been retested? Progesterone does make some women feel worse. It's what shoots up right before your period and causes PMS if other things are out of whack. But if you're deficient, that's got to be balanced, because low progesterone causes anxiety. That was also my case and I'm feeling better since increasing it. It may not only be progesterone, but something underlying that is causing the progesterone and other things to be out of whack. Sometimes that underlying factor is low thyroid. The thyroid has to be in sync for any of the other hormones to do their job. But then, one asks, what's causing the low thyroid? Well, it's probably because somewhere along the way our hypothalamus/pituitary got bonked, usually through stress, and stress can be psychological as well as environmental, like pesticides, chlorides.
The hypothalamus pretty much controls the thyroid and indirectly the sex hormones and the whole hormonal show. If it's bonked and keeps getting bonked through stress (stress hormones are toxic to this brain stucture) you're going to have ongoing and increasingly worsening problems. Sometimes you can 'heal' it by providing the right external boosts to give it a chance to reset it's feedback loop signalling function. This might be psych meds that reduce stress reactions while the overall brain and body recuperates. Give the body the right hormones and you take stress off the organs which get totally confused when they're not getting the proper signals from the hypothalamus. Thyroid is critical for all this to work. It controls metabolism, homeostasis - a cellular sparkplug, but also the sex hormones which are crucial for the brain hormones to work - little known fact. Thyroid influences estrogen production and estrogen is needed by the brain to prime certain receptors, serotonin's among others. It's all such an interconnected loop. Notice how meds keep losing their effectiveness, like ooops, need a bigger bandaid here. One small hiccup and eventually the whole system gets thrown off and the weakest link is going to break first. For many of us, that weakest link is our brain health. One begins to see that you can't just hit one pathway with meds, physical or mental, and expect a lasting change.
You ask if my naturopath works like your doc. Hard to say, but she does work very differently than most of the other docs I've ever gone to. She uses saliva testing primarily (ZRT Labs in Portland, OR) for hormone testing and standard lab work for the rest. She monitors progress using tests so she's not shooting in the dark and she goes slowly, building up one system and then adding another with the philosophy that a weakened system can't handle too much too quickly. She's an incredible diagnostician and based on symptoms knows which tests to order first, and then goes slowly from there. She feels that most health and mood disorders are hormone related but so much can contribute to that. She does alot of testing for heavy metals. A friend's test came back extremely high for mercury toxicity and sure enough, all the symptoms of mercury toxicity were what she was experiencing. She is very depressed also, but differently than me, and her hormonal profile was different than mine.
I had significant hormonal imbalances but I wasn't getting better even though I'd had prior hormone therapy (good enough but not the sufficient) and nothing was holding. She suspected that I had low growth hormone because I have fibromyalgia and in her experience, that's pretty typical. Sure enough, the test came back with a very very low IGF-1 level indicating hardly ANY human growth hormone. Now, HGH is the major hormone produced by the pituitary in the brain and it's a critical player in this whole hypothalamus/pituitary loop system. So even though I was taking individual hormones, nothing was lasting for long because the underlying deficiency wasn't getting addressed. So, we tracked an underlying cause to this human growth hormone deficiency which at this point looks like it's the common denominator in this whole imbalance. I'm now injecting myself every morning with HGH which is very expensive and I sure hope it works. It's slow acting, 6 months or more, but it will cascade down to create overall hormonal health. But until then, I'm feeling much better already since I'm now using a better balance of hormones and switched from Synthroid to a natural form of thyroid hormone with T3. I have also increased lamictal and I think it's had a positive effect on my mood. My energy and general health is so much better that my mood is better and vice versa. I may be on psych meds forever, but that's OK because I'm expecting them to work so much more effectively. Perhaps one day I'll be able to manufacture the necessary neurochemicals on my own, but I bless those pills anyway!
I definitely think that addressing underlying imbalances was necessary in my case. This may not be so with everyone and many times simply removing chronic stress through taking the right psych-meds is enough to allow the body to regain homeostasis, but whatever method, the body/mind have to come to some kind of agreement about stress. For me, my stress was extreme, started very young since my father was a very violent man, and has been going on for over 40 years. In my case, fibromyalgia seems to be a last-ditch attempt by my body to just say no to stress, much like a circuit breaker. It's brought me to my knees, can't work in my hellish high tech field anymore and am now on disability. It shuts me down completely for weeks at a time in intense pain, fatigue, insomnia. I rarely go out on the town anymore and have to call it a night by 11:00 no matter what I'm doing or where I am. And I bless it's nasty and painful little heart otherwise I would've pushed myself into the ground. I've always had mood disorders, but fibro is a whole other thing, a whole body and mind pain and an outcome of unrelenting stress. Fibro, like shit, happens.
So I say all this rambling to illustrate that we all have different chemistries and we all have to sleuth out what's going on under the obvious surface and it has to be a slow process because things like hormones take at least a year to balance IF you're getting the proper treatment. You also need to be working pretty closely with someone, as in teamwork, and not expect that to see someone a few times and getting some meds is going to do the trick. My experience with seeing well over 100 health practitioners is that you have to do your own homework all throughout your treatment. Also, with the many holistically oriented MDs I've seen, few were really helpful, and few really knew the delicate interplay of the hormonal systems. And for God's sake, stay away from Endocrinologists unless he/she has first been canonized a Saint!
For you, it may be something else entirely, but the fact that you've got test results that show imbalances is very significant. It may not be the entire answer, but you've got to at least get these imbalances in order and anything else that crops up because of your current dysfunctions. Otherwise, it's all bandaids. - BCat
Posted by nmk on September 29, 2003, at 12:41:57
In reply to Folic acid and other ramblings » nmk, posted by BarbaraCat on September 26, 2003, at 23:18:32
Hi Barbara,
Sorry for the late reply. The depression came back this past weekend after two months of feeling well. Someone up there is playing a cruel joke on me. It started two days before my period with intense anxiety and then the day I started, I spiraled downward. I have a call into my pdoc and I know he will tell me to continue the titration on the Lamictal, which I have already done. I am up to 225 mg this week and I just need to wait it out. I am so down and can barely keep it together at work today. I was in a meeting this morning trying to focus on the topic at hand but my mind was elswhere. I felt as though I was just staring at people,responding with the occassional "sure", "yes", "blah, blah, blah".
You mentioned in your response that you are taking a natural T3 thyroid med. Is it Amour (sp?)Thyroid. What dose have you found beneficial? Also, should T3 be taken alone or is it better to combine a T3/T4 med? I was taking Synthroid a year ago and it did nothing for me. Your comment about endo's rang true....i saw one a few months ago and was diagnosed with Hashimoto's and he stated that I did not need meds at the present time. I ran from his office and tried the naturopath. I will address the T3 med with him.
I read in a recent thread that you are thinking of Seroquel for sleep. For me, I was able to achieve a solid, almost comatose-like sleep. The unfortunate side was that I felt hungover and foggy in the morning and this didn't clear until around noon. I was taking 25mg at night so you may want to try cutting it in half for starters. I have read that this works well for some.
Well, I should get back to work, although I feel like pouring my heart out. This is all so depressing.
Thanks for listening Barbara.
Nicole:(((
Posted by BarbaraCat on September 29, 2003, at 14:26:21
In reply to Re: Folic acid and other ramblings » BarbaraCat, posted by nmk on September 29, 2003, at 12:41:57
Hi Nicole,
Waaah! It does seem like a cruel joke, you just get used to feeling better, then - wham! BUT, another way to look at these moods is they're a very healthy response to something else that's not working. Your endo sounds like a class A idiot. That's been my beef with many of the docs I've been to. My PCP internist was baffled by my ping-ponging TSH levels, not aware of the fact that lithium interferes with thyroxine uptake, and sent off my case to the 'head endo' at my HMO. I had a chance to see my med records and saw his notes. With average TSH range being 0-5, my TSH was boinging from 17 down to .09, up to 7.0, down to .03, up to 4.1 all within the space of 5 months. He said that, while somewhat unusual, these fluctuating extreme levels shouldn't produce any clinical symptoms!!!. Up, down, all around - and this doesn't ring any bipolar bells with them? He basically said that he saw no reason to test me for Hashi's, free T3/T4 levels or any other test besides the vanilla TSH. He never mentioned lithium and advised my PCP to keep going with the ineffective Synthroid treatment which 'should be adequate' and to suspect that any claims of thyroid related health issues were due to my 'emotional lability'. My husband practically had to tie me down when I read that crap. He's the HEAD of the endo department which means it probably gets worse downline.So now I'm on 1G of Westhroid, naturally-derived as is Armour. My naturopath switched from Armour because a student whom she was advisor for did her research paper on the consistency of different natural thyroid meds and found Armour to be very inconsistent. I've heard other accusations about this that Forrest Labs vehemently denies, but there you go. Westhroid came out on top.
The T4/T3 and some T2/T1 is in dessicated thyroid, and there's some evidence that the other T's are beneficial. My personal feeling about T3 alone is that it's not good, especially for bipolars and those prone to anxiety. It enters the blood stream fast, is the active component, shoots the thyroid way up, and can cause hypomania, anxiety, heart arrythmias, sweating, headaches, hypomania, acne. It's excreted quickly and so the body goes through spiking. T4 is slower and longer lasting and supposedly converts into the active T3 form, which is why most docs feel that T4 is enough to do the job. But many of us don't convert it properly and/or there's a problem with getting both T3 or T4 into the cells and so the free form just circulates in the blood, tricking the hypothalamus/pituitary into thinking that there's enough thyroid hormone, thanks but don't make any more. I've been taking L-tyrosine 1000mg/day along with 500mg B6 and 2G Vitamin C which helps the T4/T3 conversion. I notice more energy since taking it.
Some schools of thought suspect that low thyroid isn't a problem with the thyroid gland but is an immune system dysfunction. In fact, Hashimoto's is the body's own immune system attacking the thyroid gland, and is cropping up more and more, mainly because auto-immune and inflammatory conditions can be the result of environmental toxins and toxic stress. So, if you have a clear cut dx of Hashi's, well, I can't even imagine what your endo must be thinking. Even if it's 'borderline' Hashmoto's indicates a wider spread inflammatory condition. Your naturopath should help you with this. You might want to get saliva testing to look at your cortisol levels since cortisol is what affects the immune response, whether high or low. BTW, cortisol also affects the production of sex hormones.
I'm not taking Seroquel but have been talking to Serena about it recently. She seems to indicate that it's been enough to control her fibromyaligia and bipolar. I'm trying to not use anything to sleep cause that's so much healthier but if I start having problems again, Seroquel sounds like the ticket. Are you taking it for any other reason than sleep? Does it help with BP? In other words, why did your pdoc decide upon Seroquel for you?
So, about your PMS, Hashimoto's and such. That's going to make you feel like major doo-doo. PMS usually means there's an imbalance between estrogen/progesterone which is exacerbated pre-period, but doesn't entirely go away. The thyroid is intrinsically linked with estrogen and to a lesser degree progesterone. I hope your naturopath is helping you with this because you'll feel so much better once these underlying problems are balanced and you won't until things start the healing process.
Hang in there, kiddo! You know how this mood disorder thing is, it's like the weather - wait a few minutes and it'll change. In the meantime, just think how great you'll feel when you start feeling good again - and I have total faith that you'll find your way. - Barbara
Posted by nmk on September 30, 2003, at 12:06:08
In reply to Re: Folic acid and other ramblings » nmk, posted by BarbaraCat on September 29, 2003, at 14:26:21
Barbara,
Wow! I wish you were my physician....you know more than any docs I have encountered. Now go get your MD.
Just to clarify your response regarding the Westhroid. Is it only a T3 and you are supplementing it to aid in the conversion of T3 to T4 or is Westhroid a combined T3/T4 med? I will be sure to discuss this with my naturopath the next time I see him, although I know he is a big proponent of Amour. Like you, Synthroid did zilch for me and I know I need to try a different path.
As always, thanks for everthing Barbara.
PS Today I am feeling a bit brighter. I think the increase in Lamictal may be kickin' in.
Nicole :)
Posted by BarbaraCat on September 30, 2003, at 15:17:33
In reply to Re: Folic acid and other ramblings » BarbaraCat, posted by nmk on September 30, 2003, at 12:06:08
Thanks for your vote of confidence, Nicole. I've had many years to devote to learning about my own condition and about other areas of health that interest me. I've gained a great respect for these wondrous bodies of ours - so fascinating and really require very little outside of the basics!
I respect MDs for their ability to handle crisis care, like broken bones, appendixes, pneumonia, surgeries - things that require quick action. When I've needed stiches, had pneumonia, car accident, my first thought was 'Emergency Room!' and not my naturopath. But, unfortunately they come short on wellness care, and we're all suffering for it.
So, Westhroid is a natural dessicated thyroid hormone derived from pigs or cows. It's the same as Armour, a natural thryoid with the same ratio of T4/T3. I'm taking it by itself and no longer take the T4 Synthroid generic. Natural thyroid hormone, whether Armour, Westhroid or others, contain the whole thyroid gland. There are other types of thyroid hormones like T1/T2 in the pills. We also have T1 and T2. No one at this point is sure what they do, but there must be a reason why they're there, eh? The only difference between Armour and Westhroid is they're made by different companies and the potency of Westhroid has been said to be more consistent than Armour. In fact, there's currently a legal case against Armour for that reason, along with some other reasons I'm not up on. Armour used to be made by the 'Armour Thyroid' company which has been bought over by Forrest Labs. Forrest Labs makes other kinds of drugs as well and keeps Armour on board, but it's not a big money maker for them with little incentive to put alot of energy into, from what I've been hearing for many years.
I've taken Armour before for quite a while and stopped because it just felt 'rough' and seemed to vary from batch to batch. I was getting too much T3 and felt hyper. Since being on Westhroid it feels alot smoother. There's a great website that will tell you more than you could ever possibly digest about thyroid:
You won't find much against Armour because they take a sympathetic stand for it, but I believe it's got more to do with defending natural vs. synthetic than the actual Armour brand. Armour is the oldest and most well-known brand of natural dessicated thyroid and so many folks aren't aware that there are other brands out there.
Ask your doctor about taking L-Tyrosine as well. It's a precursor amino acid that helps to convert T4 to T3, and helps with cellular uptake. L-Tyrosine also has other powerful properties involved in the production of norepinephrine and dopamine - very crucial for us poor neurotransmittor challenged folks! It's an effective antidepressant for many, myself included! You need to take it in the morning along with Vitamins B6 and C and a little protein. I've got some more info on it but it's in .pdf format and my Acrobat program got corrupted.
I'm finding an extra little dab of Lamictal is helping as well. It's a great drug and I'm soooooo thankful for it. Just about every psychotropic med has pass through these lips and you get kinda discouraged when they keep fizzling. Just hope I don't get the intense itchies like last time when I increased it, maybe a little too fast. So, here's to us and keeping up our improvements! - Barbara
Posted by nmk on October 1, 2003, at 12:08:22
In reply to Westhroid vs. Armour thyroid » nmk, posted by BarbaraCat on September 30, 2003, at 15:17:33
Thanks Barbara for the Westhroid information...sounds very promising and I will ask my doc for a trial run at my next visit. I just want to make sure I don't over do it with the T3 for fear that my anxiety level will sky rocket further than it already is.
I am glad the increase in Lam is working for you too. I am still doing well and have crawled out of the black hole I was in this past weekend. I love the med but I find it so activating.....I feel a little hyper and racey (if that is a word). By far, it beats feeling depressed but it doesn't help with the anxiety much. I have also found that with higher doses (I am at 225mg) I get headaches every day. This is a small price to pay for beating the blues. I just hope two tylenol's per day won't harm me too much.
Continue to feel well and a big hug to you.
Nicole
Posted by jrbecker on October 1, 2003, at 23:23:28
In reply to Folic acid and other ramblings » nmk, posted by BarbaraCat on September 26, 2003, at 23:18:32
I also take folate and b12 in combo. the best version of b12 I've found is by far the methylcobalamin form -- also known as brain b12. it has a much higher blood-brain barrier permeability than regular b12 (cyanocobalamin). the methylcobalamin form is harder to find, but it's usually available in most specialty health food stores.
http://www.thorne.com/altmedrev/.fulltext/3/6/461.html
b12 is probably the best supplement I've found in addition to meds. It improves mood, sleep, energy, and focus, with no side effects. the folate works in similar ways I'm sure and the research currently points the finger more at folate deficiency than b12, but I feel like I'm getting more of a boost from the b12. they work great in combo, since they both effect the methylation process, believed to be important in mood/immune support/metobolism.
Posted by nk on October 2, 2003, at 12:23:12
In reply to Re: Folic acid and other ramblings, posted by jrbecker on October 1, 2003, at 23:23:28
Hi there,
My naturopath has me on injectible B12, 1cc twice per week. I had asked him if I can simply get the B12 from oral supplements and he stated that the body doesn't absorb it as efficiently. Any insight into this?
Nicole
Posted by katia on October 2, 2003, at 19:18:07
In reply to Re: How does lamictal feel and how much does it help?? » DayByDay, posted by BarbaraCat on September 22, 2003, at 14:38:22
Hey Barb,
Which site do you get cheap supplements from? I'm comparing prices to the metabolic nutritionist that I see tomorrow.
thanks.
Katia
Posted by BarbaraCat on October 3, 2003, at 0:03:56
In reply to Where to buy fish oil? » BarbaraCat, posted by katia on October 2, 2003, at 19:18:07
I like www.iherb.com. They have a huge selection and the best prices I've seen, at least 30% off retail prices. You get free shipping with orders over $40 (maybe its $50) and there are additional discounts based on how much your order and other things. Customer service is great. There are also good articles about various maladies buried within. I get most of my supplements from there.
I get my fish oil from Dr. Barry Sears of The Zone fame. Very expensive - $60 for 8 oz but I think it's the cadillac of fish oils. The other brand I get for a change of pace and expense is Carlson's 'The Very Best Fish Oil' - stupid name but a good product for alot less money. Whatever brand you go with, you have to get the liquid because taking 12G of pills would gag a horse.
Good luck with your appointment. Let me know what comes of it. - Barbar
> Hey Barb,
> Which site do you get cheap supplements from? I'm comparing prices to the metabolic nutritionist that I see tomorrow.
> thanks.
> Katia
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